Obamacare in WA State: Communication Complications Trump the Law

 — by Eric Scigliano for Crosscut.com —

Preparing for a colonoscopy is half the battle — at least if you don’t have issues with your insurance company. Credit: Ed/Flickr

When politicians, pundits and other know-it-alls tussle over whether to renovate, repeal or preserve Obamacare, they talk about Medicare expansion, the enrollment mandate and the ban on excluding pre-existing conditions. No one complains about one key provision: that insurers pay fully, with no copay or deductible required, for the most effective preventive procedures.

You might think that’s because that requirement is so clear and noncontroversial that no one, not even a flinty-eyed insurance adjuster, could look askance at it. If so, you would be wrong.

Regence BlueShield, the state’s and region’s largest insurer, doesn’t dispute that provision openly. In fact, Regence doesn’t seem to want to talk about it at all. But where it counts, in the processing of claims from thousands of member-customers, Regence, acting on behalf of the state of Washington, is brazenly defying the ACA’s requirement, amplified by follow-up federal directives, to cover one preventive procedure with proven lifesaving value.

That procedure is colonoscopy, which uses a flexible probe to detect, at a harmless early stage, the polyps that may grow into colon and rectal cancers and remove them on the spot with a hot wire extended from the probe. The U.S. Cancer Society deems it the most “sensitive” – i.e. effective – method for detecting colorectal cancer. The U.S. Preventive Services Task Force, the federal panel charged with evaluating preventive procedures, gives it a top “A” rating. You, too, may know or know of people who met a sad early end because they would not or did not have their innards probed.

(To read the full article, go to crosscut.com/2015/05/the-big-washington-dodge-on-obamacares-prevention-provision/ )